N° 75 | February 2013

Dealing with the childhood obesity epidemic: a public health approach

Childhood obesity is one of the most pressing public health and medical problems in the United States (US). In the US, prevalence rates of childhood overweight and obesity have tripled in the past 30 years and the health implications and related medical costs of the disease are already obvious. For the first time ever, weightrelated type 2 diabetes is being diagnosed in youth.

The following offers an overview of current trends and initiatives from the medical and public health communities to find appropriate and effective treatments, as well as ways to prevent obesity.

Family-based behavioral treatment programs seem to be the most effective childhood obesity treatment programs

A recent Cochrane review on treating obesity in children examined the efficacy of community, school, and clinic-based treatment programs (including lifestyle, drug, and surgical treatment)1. The majority of the lifestyle interventions focused on behaviorally oriented treatment programs while other lifestyle approaches focused on activity, reduction of sedentary behavior, or on dietary changes. Behavioral treatment programs most typically target eating and activity change in the obese child by working with parents to restructure the foods available in the home. These programs positively impact how families cue and reinforce eating and activity behaviors, and provide counseling to both parents and the obese youth. For youth under the age of 12, these familytargeted programs decreased Body Mass Index (BMI) more than standard care at 6-month follow-up, but treatment differences were not evident at a 12-month follow-up. For adolescents, these programs were found to be more effective than standard care at both 6-month and 12-month follow-up. Some medications (orlistat, sibutramine) combined with a lifestyle intervention showed significant weight loss in adolescents but also adverse outcomes like abdominal pain, gallstones, and high blood pressure.

The studies show a good effect of family-based behavioral treatment programs but they are some limitations: generally the studies include a small number of participants and there are few published studies that evaluate treatment efficacy in non-white children.

Changing foods available in schools to prevent childhood obesity

The vast majority of youth spend at least six hours, five days a week, in school. Therefore schools, and other agencies in the community that work with youth, have an important role in helping to prevent childhood obesity. Health education research has shown that knowledge alone does not result in behavior change. Behavior choices occur in the context of what youth see as options in their environment and in what they see modeled by other people in their environment. Interventions should focus on changing elements of the physical and social environments, such as changing foods available in schools or increasing physical activity options and rewarding and incentivizing healthful choices.

Public health initiatives to prevent childhood obesity

In the United States there are many initiatives from the federal government as well as non-profit institutions to help develop solutions to reduce childhood obesity. At the federal level, the Centers for Disease Control and Prevention as well as Michelle Obama’s “Let’s Move!” campaign offer recommendations for individuals, communities and local and state organizations to reduce the risk of childhood obesity. The American Academy of Pediatrics and the Robert Wood Johnson Foundation are examples of non-profit organizations that are working hard to find strategies for preventing childhood obesity.

Public Health challenges for the future

The time will tell us if these public health initiatives impact prevalence rates of childhood obesity. Flegal et al.2 report that the most recent NHANES data showed no statistically significant change in the prevalence of obesity from 1999 to 2008 for adult women. For men, prevalence rates appear to have leveled off since 2003.

The Pediatric Nutrition Surveillance System shows no increase in obesity rates in children and in students between 2005 and 2007. These are good signs but approximately 2.7 million children, ages 2-19 were at or above the 99th percentile for BMI in 2004 and nearly half a million had a BMI that met or exceeded 40 kg/m2. In particular, among those youth living in families below the poverty threshold, the rates of severe obesity tripled in the last decades. The challenge for the future is to develop more powerful treatments for these severely obese youth3.

While public health and clinical interventions appear to be in high gear to prevent and treat childhood obesity, it would be naïve to believe that childhood obesity will be eradicated like other epidemics of the past. We are no more likely to find a “cure” for obesity than we are to find a “cure” for cancer. Both diseases are highly complex and have biological, behavioral, psychological, social, and environmental etiologic factors that are not easily fixed. Those of us in public health need to do what we can to allow all of our children to achieve the highest degree of health and wellness possible.

BASED ON: LA Lytle (2012). Dealing with the childhood obesity epidemic: a public health approach. Abdom Imaging. March 7

  1. Oude Luttikhuis H, Baur L, Jansen H et al. (2009) Interventions for treating obesity in children. Cochrane Database Syst Rev, Issue 1, Art. No. CD001872.
  2. Flegal KM, Wei R, Ogden Cl, et al. (2009) Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention Growth Charts. Am J Clin Nutr 90:1314-1320
  3. Skelton JA, Cook SR, Auinger O, et al. (2009) Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr 9(5):322-329
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